Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic features

An Bras Dermatol. 2022 May-Jun;97(3):348-357. doi: 10.1016/j.abd.2021.08.008. Epub 2022 Apr 2.

Abstract

Lichen planopilaris and frontal fibrosing alopecia are primary scarring alopecias where diagnosis can be suggested by clinical and trichoscopy features, especially in the early stages, but scalp biopsy is the standard exam for definitive diagnosis. Frontal fibrosing alopecia is considered a variant of lichen planopilaris, as the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate, sometimes with a lichenoid pattern. A thorough clinical examination, trichoscopy and photographic documentation are essential to assess the evolution and therapeutic response. To date, there are no validated treatments or guidelines for these diseases, but there are recommendations that vary with the individual characteristics of each patient. This article presents a comprehensive review of the literature, including an update on topics related to the diagnosis, follow-up, histopathological aspects and available treatments for lichen planopilaris and frontal fibrosing alopecia, highlighting their similarities, differences and peculiarities.

Keywords: Alopecia; Diagnosis; Lichen planus; Review; Scalp dermatoses; Therapeutics.

Publication types

  • Review

MeSH terms

  • Alopecia / diagnosis
  • Alopecia / drug therapy
  • Alopecia / pathology
  • Humans
  • Lichen Planus* / diagnosis
  • Lichen Planus* / drug therapy
  • Lichen Planus* / pathology
  • Scalp / pathology
  • Scalp Dermatoses* / diagnosis
  • Scalp Dermatoses* / drug therapy
  • Scalp Dermatoses* / pathology

Supplementary concepts

  • Lichen planus follicularis